To amend the Social Security Act to improve choices available to
Medicare eligible seniors by permitting them to elect (instead of regular
Medicare benefits) to receive a voucher for a health savings account, for
premiums for a high deductible health insurance plan, or both and by suspending
Medicare late enrollment penalties between ages 65 and 70.

IN THE HOUSE OF REPRESENTATIVES

January 5, 2011

Mrs. BLACKBURN (for herself, Mr. ROE of Tennessee, Mr. PENCE, Mr. SESSIONS,
and Mr. PAUL) introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Energy and Commerce,
for a period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the committee
concerned

A BILL

To amend the Social Security Act to improve choices available to
Medicare eligible seniors by permitting them to elect (instead of regular
Medicare benefits) to receive a voucher for a health savings account, for
premiums for a high deductible health insurance plan, or both and by suspending
Medicare late enrollment penalties between ages 65 and 70.

Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Health Care Choices for Seniors Act'.

SEC. 2. FINDINGS.

Congress finds the following:

(1) The Social Security Administration's Program Operations Manual System
section HI 00801.002, titled `Waiver of Hospital Insurance Entitlement by
Monthly Beneficiary', provides that an individual who does not sign up for
part A of the Medicare program when the individual signs up for social security
benefits will lose such benefits, regardless of the desire of the individual
to not participate in the Medicare program because of religious or philosophical
reasons or a preference to have private health insurance.

(2) As part of the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (Public Law 108-173), Congress increased health insurance options
by authorizing health savings accounts into which individuals may make annual
contributions of not more than $2,650 and families may make such contributions
of not more than $5,250 that are allowable as deductions for income tax
purposes. Seniors are not allowed to deduct contributions to their health
savings account after the date of the entitlement of such seniors to Medicare
benefits.

(3) Section 1802(b) of the Social Security Act (42 U.S.C. 1395a(b)), added
by section 4507 of the Balanced Budget Act of 1997, states that a Medicare
beneficiary may only enter into a private contract with a physician for
an item or service if no claim for payment under title XVIII of such Act
will be submitted. In the case of such contract, the physician must sign
an affidavit that acknowledges such contract and that provides that the
physician will not submit a claim, and will forgo reimbursement, under such
title for an item or service provided to any Medicare beneficiary for a
period of two years.

SEC. 3. AUTHORITY TO ELECT VOUCHER PROGRAM INSTEAD OF MEDICARE PART A ENTITLEMENT.

(a) In General- Section 226 of the Social Security Act (42 U.S.C. 426) is
amended by adding at the end the following new subsections:

`(k) Waiver of Entitlement and Election of Voucher Program-

`(1) IN GENERAL- Notwithstanding the previous provisions of this section,
the Secretary shall establish a procedure under which an individual otherwise
entitled under subsection (a) to benefits under part A of title XVIII may
waive such entitlement and be automatically enrolled in the Medicare Alternative
Voucher Program established under subsection (l) if--

`(A) at the time such waiver is made the individual--

`(i) has a health savings account described in subsection (d) of section
223 of the Internal Revenue Code of 1986 (26 U.S.C. 223); and

`(ii) is enrolled under a high deductible health plan, as defined in
subsection (c)(1) of such section; and

`(B) the individual makes such waiver during the initial enrollment period
described in section 1837(d).

`(2) TREATMENT UNDER THE INTERNAL REVENUE CODE OF 1986- An individual who
waives entitlement under paragraph (1) shall not be treated as entitled
to benefits under title XVIII for purposes of section 223(b)(7) of the Internal
Revenue Code of 1986.

`(3) INELIGIBILITY FOR PART B OR D BENEFITS- An individual shall not be
eligible for benefits under part B or D of title XVIII during the period
for which the individual waives entitlement under part A of such title under
paragraph (1).

`(4) TERMINATION OF WAIVER AND REENROLLMENT UNDER MEDICARE PROGRAM- The
Secretary shall establish a procedure under which an individual who waives
entitlement under paragraph (1) may terminate such waiver during an annual
period that shall be the same as the annual general enrollment period described
in section 1837(e). For purposes of applying parts B and D of title XVIII,
such individual shall be treated as if the individual were entitled to benefits
under part A of such title as of the date such individual terminates the
waiver under this paragraph. An individual who has terminated such a waiver
may not subsequently make such a waiver.

`(l) Medicare Alternative Voucher Program-

`(1) ESTABLISHMENT OF PROGRAM- The Secretary shall establish a program to
be known as the Medicare Alternative Voucher Program (in this subsection
referred to as the `voucher program') consistent with this subsection.

`(2) AUTOMATIC ENROLLMENT- An individual who waives entitlement under subsection
(k)(1) shall be enrolled in the voucher program for the period during which
such waiver is in effect.

`(3) AMOUNT OF VOUCHER-

`(A) AMOUNT BASED ON AGE COHORT-

`(i) IN GENERAL- Subject to clause (ii), for each month that an individual
within an age cohort is enrolled in the voucher program, the Secretary
shall provide a voucher to such individual in an amount that is equal
to the monthly actuarial rate for that month computed under section
1818(d)(1) multiplied by the age cohort adjustment factor for such age
cohort under subparagraph (B).

`(ii) MONTHLY LIMIT- The amount of a voucher provided to an individual
for a month may not exceed $200.

`(B) AGE COHORT ADJUSTMENT FACTOR- For each age cohort the Secretary shall
determine an age cohort adjustment factor equal to the ratio of--

`(i) the monthly actuarial rate described in section 1818(d)(1) as determined
by the Secretary for individuals in such age cohort, to

`(ii) the monthly actuarial rate described in such section.

`(C) AGE COHORT DEFINED- For purposes of this paragraph, an `age cohort'
means a group of individuals whose age falls within a span of five consecutive
years, consistent with the following:

`(i) The first such span begins at age 65.

`(ii) Other spans follow consecutively.

`(4) PERMISSIBLE USE OF VOUCHER- A voucher under paragraph (3) may be used
only for the following purposes:

`(A) As a contribution into a health savings account established by such
individual, as described in subsection (k)(1)(A).

`(B) For payment of premiums for enrollment of such individual under a
high deductible health plan described in such subsection.

`(5) EFFECT OF SUBSEQUENT TERMINATION OF WAIVER- If an individual terminates
a waiver under subsection (k)(3), the enrollment of such individual in the
voucher program shall be terminated on the date on which the termination
becomes effective.'.

(b) Amendment of Internal Revenue Code of 1986- Paragraph (7) of section 223(b)
of the Internal Revenue Code of 1986 (relating to Medicare eligible individuals)
is amended to read as follows:

`(7) MEDICARE ELIGIBLE INDIVIDUALS-

`(A) IN GENERAL- The limitation under this subsection for any month with
respect to an individual shall be zero for any month such individual is
entitled to benefits under title XVIII of the Social Security Act.

`(B) MEDICARE ALTERNATIVE VOUCHER PROGRAM- In the case of an individual
who is enrolled in the Medicare Alternative Voucher Program under section
226(l) of the Social Security Act, the applicable limitation under subparagraphs
(A) and (B) of paragraph (2) shall be increased by the amount of the voucher
described in paragraph (3) of such section which is contributed to a health
savings account of such individual.'.

(c) Effective Date-

(1) IN GENERAL- The amendment made by subsection (a) shall take effect on
the date that is six months after the date of the enactment of this Act
and shall apply to an individual who becomes entitled to benefits under
part A of title XVIII of the Social Security Act on or after such date of
the enactment.

(2) AMENDMENT OF INTERNAL REVENUE CODE OF 1986- The amendment made by subsection
(b) shall apply to months ending after the date referred to in paragraph
(1), in taxable years ending after such date.

SEC. 4. SUSPENSION OF MEDICARE LATE ENROLLMENT PENALTIES BETWEEN AGES 65
AND 70.

(a) Part B- The second sentence of section 1839(b) of the Social Security
Act (42 U.S.C. 1395r(b)) is amended by inserting before the period the following:
`and there shall not be taken into account (for individuals not entitled to
benefits under section 226A) any month during any part of which the individual
attained age 65 and has not attained age 70'.

(b) Part D-

(1) IN GENERAL- Section 1860D-13(b)(7)(A) of such Act (42 U.S.C. 1395w-113(b)(7)(A))
is amended by adding at the end the following sentence: `For purposes of
the preceding sentence, in the case of an individual not entitled to benefits
under part A under section 226A, a continuous period of eligibility shall
not include any month during any part of which the individual attained age
65 and has not attained age 70.'.

(2) CONFORMING AMENDMENT- Section 1860D-1(b)(6)(A) of such Act (42 U.S.C.
1395w-101(b)(6)(A)) is amended by inserting after `paragraph (2)' the following:
`, but excluding the period between 65 and 70 years of age'.

(c) Effective Date- The amendments made by this section shall apply to individuals
who attain 65 years of age in a month after the month in which this Act is
enacted.